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Nebulizers

Coverage

Documentation

Reviews/Audits

  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

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Topic Details
Maximum Frequency replacement accessories
  • A4619, A7006, A7525, A7015: One/Month
  • A7003, A7007, A7012, A7013: Two/ Month
  • A7004: Two/ Month (in addition to A7003)
  • A7005: One/3 months only with K0730
  • A7005: One/6 months
  • A7010: One Unity (100ft.)/ 2 month
  • A7014: One/3 months
  • A7017, E1372: One/3 years
  • A7016: Two/Year
Drug Waste Modifiers
  • JW - drug amount discarded/not administered to any patient
    • Indicated for discarded drugs and biologicals from "single use vials or single use packages."
    • Effective for claims with dates of service on or after January 1, 2017, if the coverage criteria for the infusion drugs are not met, claims billed for drug wastage with the JW modifier will be denied as not reasonable and necessary.
    • Effective for claims with dates of service on or after January 1, 2017, claims lines billed for drug wastage without a JW modifier will be denied as not reasonable and necessary.
  • JZ - zero drug amount discarded/not administered to any patient
    • Effective for use January 1, 2023, and,
    • Required for use on applicable claims with dates of service July 1, 2023
  • Indicated when there are no discarded amounts from "single use vials or single use packages."
Drugs: Maximum Milligrams/Month
  • Acetylcysteine: 74 grams/month
  • Albuterol: 465 mg/ month
  • Albuterol/Lpratropium combination: 186 units/ month
  • Arformoterol: 930 micrograms/month-62 units/month
  • Budesonide: 62 units/month
  • Cromolyn Sodium: 2480 mg/month 0248 units/month
  • Dornase Alfa: 78 mg/month
  • Formoterol: 1240 micrograms/month- 62 units/month
  • Ipratropium Bromide: 93 mg/month
  • Levalbuterol: 232.5 mg/month-465 units/month (see below for exception)
  • Metaproterenol: 2800mg/month-280 units/month
  • Pentamidine: 300mg/months
  • Revefenacin: 5250 mcg/month
  • Treprostinil: 31 units/month
  • Sterile Saline or water, 10ml/unit (A4216, A4218): 56 units/month
  • Distilled Water, sterile water, sterile saline in large volume nebulizer: 18 liters/month

 

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Last Updated Thu, 02 Feb 2023 20:00:06 +0000

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